在多种族糖尿病高危人群中推广体育锻炼的两种干预措施的成本效益分析:对为期 48 个月的 PROPELS 随机对照试验的经济评估。

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Laura Ellen Heathcote, Daniel J Pollard, Alan Brennan, Melanie J Davies, Helen Eborall, Charlotte L Edwardson, Michael Gillett, Laura J Gray, Simon J Griffin, Wendy Hardeman, Joseph Henson, Kamlesh Khunti, Stephen Sharp, Stephen Sutton, Thomas Yates
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引用次数: 0

摘要

导言:体力活动(PA)对 2 型糖尿病(T2D)具有保护作用。然而,有关通过增加体育锻炼来降低罹患 T2D 风险的长期实用干预措施的数据却十分缺乏。本研究调查了在多种族 T2D 高危人群中采取务实的 PA 干预措施的成本效益:我们利用 PROPELS 试验数据和 NAVIGATOR 试验分析,对公共卫生研究学院的糖尿病预防模型进行了调整。计算了每种干预措施(Walking Away (WA)和Walking Away Plus (WA+))相对于常规护理的终生成本、终生质量调整生命年(QALYs)和增量成本效益比(ICERs),并与美国国家健康与护理卓越研究所(National Institute for Health and Care Excellence)设定的每QALY收益20 000英镑至30 000英镑的支付意愿进行了比较。我们对 PROPELS 试验数据的结果进行了情景分析,并进行了阈值分析,以确定干预措施具有成本效益所需的步数变化:常规护理、WA 和 WA+ 的估计终生成本分别为 22 598 英镑、23 018 英镑和 22 945 英镑。估计的 QALY 分别为 9.323、9.312 和 9.330。据估计,WA+比WA更有效、更便宜。WA+与常规护理相比,每QALY收益的ICER为49 273英镑。在我们的情景分析中,无论是 WA 还是 WA+ 的 ICER 都不低于每 QALY 收益 20 000 英镑。我们的阈值分析表明,如果一项与 WA+ 成本相同的 PA 干预措施能够实现每天增加 500 步,并在 4 年内 100%保持,那么其 ICER 将低于 20 000 英镑/QALY:我们发现,在每 QALY 收益 20 000 英镑的限度内,WA 或 WA+ 都不具有成本效益。我们的阈值分析表明,如果增加步数的干预措施能更大程度地长期保持效果,那么在这一阈值下也具有成本效益:ISRCTN83465245:通过结构化教育和不同程度的持续支持促进糖尿病前期患者的体育锻炼(PROPELS)https://doi.org/10.1186/ISRCTN83465245。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cost-effectiveness analysis of two interventions to promote physical activity in a multiethnic population at high risk of diabetes: an economic evaluation of the 48-month PROPELS randomized controlled trial.

Introduction: Physical activity (PA) is protective against type 2 diabetes (T2D). However, data on pragmatic long-term interventions to reduce the risk of developing T2D via increased PA are lacking. This study investigated the cost-effectiveness of a pragmatic PA intervention in a multiethnic population at high risk of T2D.

Materials and methods: We adapted the School for Public Health Research diabetes prevention model, using the PROPELS trial data and analyses of the NAVIGATOR trial. Lifetime costs, lifetime quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each intervention (Walking Away (WA) and Walking Away Plus (WA+)) versus usual care and compared with National Institute for Health and Care Excellence's willingness-to-pay of £20 000-£30 000 per QALY gained. We conducted scenario analyses on the outcomes of the PROPELS trial data and a threshold analysis to determine the change in step count that would be needed for the interventions to be cost-effective.

Results: Estimated lifetime costs for usual care, WA, and WA+ were £22 598, £23 018, and £22 945, respectively. Estimated QALYs were 9.323, 9.312, and 9.330, respectively. WA+ was estimated to be more effective and cheaper than WA. WA+ had an ICER of £49 273 per QALY gained versus usual care. In none of our scenario analyses did either WA or WA+ have an ICER below £20 000 per QALY gained. Our threshold analysis suggested that a PA intervention costing the same as WA+ would have an ICER below £20 000/QALY if it were to achieve an increase in step count of 500 steps per day which was 100% maintained at 4 years.

Conclusions: We found that neither WA nor WA+ was cost-effective at a limit of £20 000 per QALY gained. Our threshold analysis showed that interventions to increase step count can be cost-effective at this limit if they achieve greater long-term maintenance of effect.

Trial registration number: ISRCTN registration: ISRCTN83465245: The PRomotion Of Physical activity through structuredEducation with differing Levels of ongoing Support for those with pre-diabetes (PROPELS)https://doi.org/10.1186/ISRCTN83465245.

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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
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